{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C EINNOCKCIWDAH","gend":1,"add":"YVI 741ES TS ","city":"EPHRATA","state":"WA","zip":98823,"dob":"1943-03-16","age":"","mstatus":"","insh":"16904910495","cliId":"","pno":"4890547974","cno":"5098447974","email":"","ename":"","eno":"","pphy":"SETH CALDWELL","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"Grant","pcpid":"","pcpname":"","plan":"Health Alliance","program":"Medicare Advantage","lob":"Confluence","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":"1902203656"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N30.00","F03.90","D500","K254","N1831","G301","G20","F0280","E1169","E782","E1165","F0281","I480","M5450","M546","W19XXXA","K922","D649","Z23","R531","E162","M109","E1159","I152","Z9181","Z8639","F444","I4891","J45909","E119","Z7189","I10","Z0000","E039","E079","M25572","R5383","F331","Z1231","D50.0","K25.4","N18.31","G30.1","F02.80","E11.69","E78.2","E11.65","F02.81","I48.0","M54.50","M54.6","W19.XXXA","K92.2","D64.9","R53.1","E16.2","M10.9","E11.59","I15.2","Z91.81","Z86.39","F44.4","I48.91","J45.909","E11.9","Z71.89","Z00.00","E03.9","E07.9","M25.572","R53.83","F33.1","Z12.31"],"date":["2023-05-02","2023-05-02","2022-12-28","2022-12-28","2022-12-28","2022-12-19","2022-12-19","2022-12-19","2022-09-21","2022-09-21","2022-09-21","2022-09-06","2022-09-06","2022-08-24","2022-08-24","2022-08-24","2022-08-16","2022-07-25","2022-07-25","2022-07-25","2022-07-21","2022-07-19","2022-01-04","2022-01-04","2021-10-12","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-20","2021-09-13","2021-09-03","2021-09-03","2021-08-16","2021-03-10","2020-12-15","2020-11-03","2020-06-17","2022-12-28","2022-12-28","2022-12-28","2022-12-19","2022-12-19","2022-09-21","2022-09-21","2022-09-21","2022-09-06","2022-09-06","2022-08-24","2022-08-24","2022-08-24","2022-08-16","2022-07-25","2022-07-25","2022-07-21","2022-07-19","2022-01-04","2022-01-04","2021-10-12","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-20","2021-09-03","2021-09-03","2021-08-16","2021-03-10","2020-12-15","2020-11-03","2020-06-17"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","CARBIDOPA\/LEVODOPA","0","180","Select","Select",""],["","","ALLOPURINOL","100.000MG","30","Select","Select",""],["","","ESCITALOPRAM OXALATE","20.000MG","90","Select","Select",""],["","","ATORVASTATIN CALCIUM","40.000MG","90","Select","Select",""],["","","LOSARTAN POTASSIUM","50.000MG","90","Select","Select",""],["","","ONDANSETRON HYDROCHLORIDE","4.000MG","30","Select","Select",""],["","","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100.000MG","10","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","0","10","Select","Select",""],["","","CEPHALEXIN","500.000MG","10","Select","Select",""],["","","OMEPRAZOLE","40.000MG","90","Select","Select",""],["","","METFORMIN HYDROCHLORIDE ER","500.000MG","360","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","0","8","Select","Select",""],["","","NAPROXEN SODIUM","550.000MG","60","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}